Australian participants in British nuclear tests in Australia

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1 Australian participants in British nuclear tests in Australia Vol 2: Mortality and cancer incidence May 2006 Richard Gun, Jacqueline Parsons, Philip Ryan, Philip Crouch and Janet Hiller Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide

2 Commonwealth of Australia 2006 ISBN This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at Published by the Department of Veterans Affairs, Canberra, Production by Biotext Pty Ltd, Canberra

3 2 June 2006 Mr Bruce Billson MP Minister for Veterans Affairs Parliament House CANBERRA ACT 2600 Dear Minister I have pleasure in submitting the final reports of the Australian Participants in British Nuclear Tests in Australia, Dosimetry and Mortality and Cancer Incidence Study, which have been prepared on behalf of the Repatriation Commission by the Department of Public Health at the University of Adelaide and members of the Dosimetry Subcommittee. I would personally like to thank all the researchers for their hard work on this study. On 16 July 1999, the former Minister for Veterans Affairs, the Hon Bruce Scott MP, announced that a cancer and mortality study of Australian nuclear test participants in British tests in Australia would be conducted. The aim of the study was to examine whether there is an increased rate of death and cancer among male nuclear test participants compared to the general Australian community. The study has taken a significant time to complete. This was due to the need to develop a nominal roll of Australian participants in the tests, which was required as the starting point for the study, and the complexity of reconstructing radiation dosage estimates received by participants at the test sites. The Scientific Advisory Committee had the role of reviewing and advising on the methodology of the study, and supervised the report s preparation. The membership of the Committee is set out at Appendix 3 of the Dosimetry Report. In addition, an Exposure Panel was established to reconstruct ionising radiation dose estimates for participants of the tests, and its membership is outlined at Appendix 4 of the Dosimetry Report. I would like to take this opportunity to thank the members of the Consultative Forum for their contribution during the conduct of the study. Due to the length of time over which the study was conducted, a number of changes in membership took place. A full list of members, and the organisations they represented, can be found at Appendix 2 of the Dosimetry Report. Finally, I would like to thank all the departmental staff who worked on this study. Yours sincerely Simon Harrington COMMISSIONER

4 The University of Sydney School of Public Health Professor Bruce Armstrong AM FAA Director of Research, Sydney Cancer Centre Professor of Public Health and Medical Foundation Fellow 1 June 2006 Level 6 Gloucester House Royal Prince Alfred Hospital Missenden Rd Camperdown 2050 AUSTRALIA Phone: +61 (0) Fax: +61 (0) Rear Admiral C S H Harrington AM RAN (Retd) Repatriation Commissioner PO Box 21 Woden ACT 2606 Dear Rear Admiral Harrington I am writing to you as Chair of and representing the Scientific Advisory Committee to the studies of dosimetry and mortality and cancer incidence in Australian participants in the British nuclear tests in Australia. I am pleased to report that the members of the Committee, with one exception, consider that the studies have been conducted and analysed to a high level of scientific quality and that the final reports of them entitled Australian Participants in British Nuclear Tests in Australia, Dosimetry and Mortality and Cancer Incidence Study, prepared for the Repatriation Commission by the Department of Public Health at the University of Adelaide and members of the Dosimetry Subcommittee, accurately represent and soundly interpret the studies findings. Towards the end of the Committee s consideration of the reports, there was contention over the content and wording of some parts of them; particularly the section entitled Main Findings. Most of the Committee members present at the time considered the matters under contention to be matters of presentation not of science. However, the contention was not resolved and Ms Ann Munslow-Davies, the Consultative Forum representative on the Committee, felt, in consequence, that she could not endorse the reports. Yours sincerely Bruce Armstrong cc Mr Barry Telford Chair Consultative Forum Australian Participants in British Nuclear Tests in Australia Study PO Box 21 WODEN ACT 2606

5 Main findings The study to investigate the health effects of participation in the British nuclear tests in Australia is reported in two volumes. Volume 1, the radiation dosimetry study, used data from the tests and modelling to estimate the radiation exposure of participants in the tests. Volume 2 includes: the mortality study, which compared the number of deaths in test participants with that of the general population from the time of the nuclear tests to the end of 2001; and the cancer study, which compared the number of cases of cancer, whether fatal or not, in test participants, with that in the general population from 1982 to the end of 2001, and compared radiation exposure of participants with and without leukaemia. The overall death rate in test participants was similar to that of the general population. There were 4233 deaths observed in participants, compared with 4150 expected from the general population. The most common cause of death in test participants was cancer, and death from cancer was 18% greater in test participants than would be expected in the general population. Deaths from causes other than cancer were generally fewer than expected in test participants compared with the general population, with the number of deaths from heart disease, cerebrovascular disease (mostly strokes), and external causes (suicide, accidents, poisonings, etc) fewer than expected. The number of deaths from respiratory diseases in test participants was about the same as expected from the general population. The cancer incidence study showed an overall increase in the number of cancers in test participants, similar to that found in the mortality study. The number of cancer cases found among participants was 2456, which was 23% higher than expected. A significant increase in both the number of deaths and the number of cases was found for (figures in brackets show increase in mortality and incidence): all cancers (18% and 23%) cancers of the lip, oral cavity and pharynx (50% and 41%) lung cancer (20% and 28%) colorectal cancer (24% and 16%) prostate cancer (26% and 22%). The number of cancer cases (but not the number of deaths) was also significantly greater in test participants for the following cancers (figures in brackets show increase in incidence): oesophageal cancer (48%) melanoma (40%) all leukaemias (43%) all leukaemias except chronic lymphatic leukaemia (61%). v

6 Other findings included: of the 26 mesothelioma cases in test participants, 16 occurred in RAN personnel, which was nearly three times the number expected in RAAF personnel, there was nearly double the expected number of deaths from melanoma, and cases of melanoma were increased by two thirds. The increases in cancer rates do not appear to have been caused by exposure to radiation. No relationship could be found between overall cancer incidence or mortality and exposure to radiation. None of the above cancers occurring in excess showed any association with radiation exposure in this study. In particular, there was no link between radiation exposure and leukaemia, excluding chronic lymphatic leukaemia (non-cll leukaemia), which is commonly found to be increased in groups exposed to radiation. These findings are consistent with the low levels of radiation exposure found in this study. Only 4% of the study population had an estimated radiation exposure greater than 20 millisieverts (msv) from test participation, and 79% had an estimated exposure of less than 1 msv. The estimated mean radiation exposure of the study population due to participation in the tests was 2.8 msv, only slightly greater than the background exposure received by every Australian every year. In the absence of a correlation with radiation exposure, the excess of non-cll leukaemia is unexplained. Other than radiation, the best established cause of leukaemia is exposure to benzene, but there is no information available about benzene exposure in test participants. Mesothelioma is a cancer that is nearly always associated with past exposure to asbestos, and the excess mesothelioma in RAN personnel is most likely due to asbestos in naval vessels. The asbestos exposure need not necessarily have occurred at the time of the nuclear tests. Lung cancer is strongly related to smoking, and the excess could be due to a higher smoking prevalence in test participants. Oesophageal cancer and cancers of the lip, oral cavity and pharynx are also known to be strongly smoking-related. Together, the excesses of these cancers indicate that there was probably a higher smoking prevalence in participants than in the general population. However, some contribution to the lung cancer excess is also likely from asbestos in RAN personnel, and possibly in civilian participants also. The occurrence of mesothelioma in RAN and civilian subjects is a definite indication of asbestos exposure, and occurrence of other asbestos-related diseases would therefore not be surprising. The occurrence of lung cancer cases is also highest in RAN and civilian subjects. Many of the civilian subjects in the cohort were in the construction industry, where asbestos was commonly used, at a time when less caution was exercised than in recent years. Whether any of these subjects were exposed to asbestos during the nuclear tests is not known. Asbestos exposure is also a possible contributing factor to the excess of colorectal cancer. The incidence of this cancer was also highest in RAN and civilian personnel. vi Australian participants in British nuclear tests in Australia Vol 2: Mortality and cancer incidence

7 Contents Main findings...v Executive summary...xvii 1 Introduction Background Description of the testing program in Australia Role of Australian personnel Army Royal Australian Navy Royal Australian Air Force Civilians Health effects of ionising radiation Structure of the study and reports Aims of the study Administrative structure Acknowledgments References Mortality study design Retrospective cohort study Choice of comparison population Addressing the healthy worker effect Social class effect Selection effect Internal comparisons Veterans of Korean and Vietnam conflicts Outcomes of interest Examination of latency References...19 vii

8 3 Mortality study methods The Nominal Roll of Australian Participants in the British Atomic Tests in Australia Development of the Nominal Roll Limitations of the nominal roll Defining the study population Details of each subject on the study roll Data sources for ascertaining vital status DVA client database National Death Index Commonwealth electoral roll Health Insurance Commission (Medicare) State death records Records from the previous study of atomic test personnel Manual search of the electoral roll England and Wales death index Servicemen s associations Department of Immigration, Multicultural and Indigenous Affairs Cancer incidence search Ascertainment of cause of death Coding from the National Death Index Coding of deaths by NCCH Quality control Exposure assessment Deriving person-years of follow-up Entry date Cutoff date Follow-up time Treatment of subjects lost to contact Analysis National mortality data Measures of mortality Confounding Estimating cancer mortality rates from hypothetical levels of smoking prevalence Software Ethics approval References...37 viii Australian participants in British nuclear tests in Australia Vol 2: Mortality and cancer incidence

9 4 Description of the mortality study cohort Study population by service category Excluded subjects Attendance and frequency of attendance at test sites Age of study population Rank of the military participants Participation in conflicts in Korea and Vietnam Exposure to ionising radiation Summary of vital status determination Mortality study results Interpretation of results All-cause mortality Mortality by major cause Effect of excluding Korean and Vietnam war veterans Cancer mortality Cancer mortality by service All-cause mortality by rank All-cause mortality by radiation exposure category Cancer mortality by radiation exposure category Cancer mortality by time since entry into the cohort Smoking prevalence and selected cancer mortality Deaths in the first two years of follow-up References Mortality study discussion Treatment of subjects lost to follow-up Mortality in the cohort Leukaemia, excluding chronic lymphatic leukaemia...59 ix

10 6.4 Mortality from other cancers Lung cancer and mesothelioma Cancer of the lip, oral cavity and pharynx Melanoma Colorectal cancer Other causes of death Comparison with other studies Methodological issues Defining the study population Ascertainment of deaths Classification of causes of death Evaluation of healthy worker effect References Cancer incidence study design Components of the study of cancer incidence Retrospective cohort study Choice of comparison population Outcomes of interest Internal comparisons between categories of radiation exposure Case control study of leukaemia References Cancer incidence study methods Retrospective cohort study of cancer incidence Defining the study population Radiation exposure assessment Search for incident cancers Privacy constraints Coding of cancers Deriving person-years of follow-up Computation of follow-up time National cancer incidence data Measures of incidence Confounding Estimating cancer rates from hypothetical levels of smoking prevalence Case control study Privacy considerations...81 x Australian participants in British nuclear tests in Australia Vol 2: Mortality and cancer incidence

11 8.2.2 Case identification Case verification Control selection Radiation exposure estimation Reliability estimation Validity testing Analysis Software References Description of the cancer incidence study cohort Study population by service category Age of study population Rank of the military participants Exposure to ionising radiation Cancer incidence study results Interpretation of results All-cancer incidence Incidence of specific cancers Cancer by service Cancer by radiation exposure Smoking prevalence and predicted cancer incidence Conclusion Case control study results Number of cases and controls Leukaemia subtypes Differences in exposure assessment for the case control study Test for replicability of radiation assessments in the case control study Correlation with assessments from subject interviews Result of analysis xi

12 11.7 Sensitivity testing References Cancer incidence study discussion Treatment of subjects lost to follow-up Comparison with other studies Reconciliation with the mortality study Individual cancer types Non-CLL leukaemia Chronic lymphatic leukaemia and all leukaemias combined Mesothelioma Lung cancer Melanoma Colorectal cancer Oral cancer Prostate cancer Overview of the effect of radiation exposure Methodological issues References Appendix 1 The study protocol Appendix 2 Mortality results including Method Appendix 3 Cancer incidence results including Method Appendix 4 The healthy worker effect Appendix 5 Hypothetical smoking prevalence Appendix 6 Abbreviations used in this report Tables Table 1 Table 2 Standardised Mortality Ratios (SMRs) for main causes of death...xxi Standardised Mortality Ratios (SMRs) and Standardised Incidence Ratios (SIRs) for selected cancers...xxi xii Australian participants in British nuclear tests in Australia Vol 2: Mortality and cancer incidence

13 Table 1.1 The major nuclear explosions in the British nuclear testing in Australia...5 Table 4.1 The study population by service category...39 Table 4.2 Excluded subjects...39 Table 4.3 First test attendance numbers at each test, by service...40 Table 4.4 Frequency of test attendance by service...40 Table 4.5 Year of birth distribution...40 Table 4.6 Age at entry to the cohort...41 Table 4.7 Rank by service category...41 Table 4.8 Participation in conflicts in Korea and Vietnam...41 Table 4.9 Estimated exposure to ionising radiation...42 Table 4.10 Follow-up results...43 Table 5.1 All causes of mortality: observed and expected deaths, SMRs and 95% confidence intervals for the cohort and selected groups within the cohort...46 Table 5.2 Major causes of mortality: observed and expected deaths, SMRs and 95% confidence intervals for the cohort...46 Table 5.3 Major causes of mortality: observed and expected deaths, SMRs and 95% confidence intervals for the military participants...47 Table 5.4 Major causes of mortality: observed and expected deaths, SMRs and 95% confidence intervals for the civilian participants...47 Table 5.5 Mortality from all causes combined: for military participants excluding veterans of Korean and Vietnam wars...48 Table 5.6 Mortality from cancer: observed and expected deaths, SMRs and 95% confidence intervals for the cohort...49 Table 5.7 Selected causes of cancer mortality: observed and expected deaths, SMRs and 95% confidence intervals for all military participants, and all military participants excluding Korean and Vietnam veterans...50 Table 5.8 Selected causes of cancer mortality: observed and expected deaths, SMRs and 95% confidence intervals, by branch of armed service...51 Table 5.9 Selected causes of cancer mortality: observed and expected deaths, SMRs and 95% confidence intervals for civilian participants...52 Table 5.10 Mortality from all causes combined and from non-cll leukaemia: comparisons within military participants based on rank...52 Table 5.11 Mortality from all causes combined: comparisons within the cohort based on exposure to ionising radiation...53 Table 5.12 Mortality from cancer: comparisons within the cohort based on exposure...53 Table 5.13 Mortality from non-cll leukaemia: comparisons within the cohort based on exposure...54 xiii

14 Table 5.14 Mortality from selected cancers: comparisons within the cohort based on radiation exposure...54 Table 5.15 Mortality from all causes combined: comparisons within the cohort based on time since entry to the cohort...55 Table 5.16 Mortality from cancer: comparisons within the cohort based on time since entry to the cohort...55 Table 5.17 Mortality from non-cll leukaemia: comparisons within the cohort based on time since entry to the cohort...55 Table 5.18 Expected number of deaths from selected cancers according to hypothetical smoking prevalence...56 Table 5.19 Deaths that occurred in the first two years after entry to the cohort...56 Table 6.1 Expected number of non-cll leukaemia deaths from radiation exposure at test sites...61 Table 6.2 Age-standardised lung cancer rates (cases per person-years, for successive editions of the IARC CI5 project: UK and Australia) a...63 Table 6.3 Cancer SMRs from the Australian and UK studies of nuclear test participants and the study of Australian veterans of the Korean War...67 Table 9.1 The study population by service category...85 Table 9.2 Year of birth distribution...86 Table 9.3 Age at entry to the cohort (1 January 1982)...86 Table 9.4 Rank by service category...87 Table 9.5 Estimated exposure to ionising radiation...87 Table 10.1 Incident cancers: observed cases, expected cases, standardised incidence ratios and 95% confidence intervals for the cohort, by type of cancer...90 Table 10.2 Military participants SIR for selected cancers...91 Table 10.3 Civilian participants: SIR for selected cancers...92 Table 10.4 RAN participants: SIR for selected cancers...93 Table 10.5 Army participants: SIR for selected cancers...94 Table 10.6 RAAF participants: SIR for selected cancers...95 Table 10.7 The incidence of all cancers combined: comparisons within the cohort based on exposure to ionising radiation...96 Table 10.8 The incidence of selected cancers: comparisons within the cohort based on exposure to ionising radiation...97 Table 10.9 Expected numbers of incident cancers given hypothetical smoking prevalences...98 Table 11.1 Leukaemia types in the case-control study Table 11.2 Differences in exposure assessment between the cohort and casecontrol study Table 11.3 Comparison of exposure assessments in 32 subjects between first and second case control assessments xiv Australian participants in British nuclear tests in Australia Vol 2: Mortality and cancer incidence

15 Table 11.4 Comparison of non-cll leukaemia cases and controls by category of radiation exposure Table 12.1 Cancer incidence in the Australian and UK studies of nuclear test participants and the study of Australian veterans of the Korean War Table 12.2 Cancer incidence and cancer mortality Table A1.1 All causes of mortality: observed and expected deaths, SMRs and 95% confidence intervals for the cohort and selected groups within the cohort Table A1.2 Major causes of mortality: observed and expected deaths, SMRs and 95% confidence intervals for the cohort Table A1.3 Major causes of mortality: observed and expected deaths, SMRs and 95% confidence intervals for the military participants Table A1.4 Major causes of mortality: observed and expected deaths, SMRs and 95% confidence intervals for the civilian participants Table A1.5 Mortality from all causes combined: for military participants excluding veterans of Korean and Vietnam wars Table A1.6 Mortality from cancer: observed and expected deaths, SMRs and 95% confidence intervals for the cohort Table A1.7 Selected causes of cancer mortality: observed and expected deaths, SMRs and 95% confidence intervals for all military participants, and all military participants excluding Korean and Vietnam veterans Table A1.8 Selected causes of cancer mortality: observed and expected deaths, SMRs and 95% confidence intervals, by branch of armed service Table A1.9 Selected causes of cancer mortality: observed and expected deaths, SMRs and 95% confidence intervals for civilian participants Table A2.1 Incident cancers: observed cases, expected cases, standardised incidence ratios and 95% confidence intervals for the cohort, by type of cancer Table A2.2 Military participants SIRs of selected cancers Table A2.3 Civilian participants: SIRs of selected cancers Table A2.4 RAN participants: SIRs of selected cancers Table A2.5 Army participants: SIRs of selected cancers Table A2.6 RAAF participants: SIRs of selected cancers Table 1 Ascertaining vital status Figures Figure 1 Figure 2 Prompt exposure from atomic weapons used in Japan (Source: Radiation Effects Research Foundation, 2003) Formation of the study population xv

16

17 Executive summary Between 1952 and 1957, the United Kingdom conducted 12 major nuclear weapons tests in Australia. The tests were carried out in five major operations: two at Monte Bello Islands, Western Australia (1952 and 1956); one at Emu Field, South Australia (1953); and two at the Maralinga Range, South Australia (1956 and 1957). Scientific studies on weapons components, known as minor trials, were undertaken in parallel between 1953 and 1963 at both Emu Field and the Maralinga Range. Over 16,000 Australians, both military and civilians, participated in the tests. The range of tasks performed by Australian personnel increased steadily during the various series. The first three series (Hurricane, Totem, Mosaic) had limited Australian involvement. However, by the final two series (Buffalo, Antler), Australian participation was quite extensive, including responsibility for the Maralinga Range between and following the major tests. The health effects of nuclear weapons tests on the British participants have been investigated, and three reports have been issued. In 1999, the Commonwealth Government resolved that a nominal roll would be compiled of Australian participants in the tests, and that this would form the basis for a mortality and cancer study. There are two reports from this study: Volume 1: a report on radiation exposures received by participants Volume 2: a report on mortality and cancer incidence of participants, and a case control study on the occurrence of leukaemia in relation to radiation exposure. Study population The study population was based on the nominal roll of test participants compiled by the Australian Government Department of Veterans Affairs (DVA). The study population comprised male subjects, of whom 7116 were military participants and 3867 were civilians. Subjects were followed to a cut-off date of 31 December 2001, when 5494 subjects (50%) were confirmed living, and 4427 subjects (40%) were confirmed deceased. A further 23 participants were known by DVA to be deceased, but corroborating evidence for the death could not be found. Less than 1% of participants (105 participants) were known to be living overseas or to have died overseas. The vital status of 934 subjects (8.5%) on the cut-off date was unknown. Cancer incidence was studied from 1982 to Because cancer rates in the study population were compared with national rates, which are only available from 1982 onwards, this study excluded test participants who died before This limitation probably does not greatly affect the study findings, because cancers caused by external factors do not usually develop until many years after initial exposure. xvii

18 Study methods Mortality rates and cancer incidence rates in participants were compared with national rates, compiled by the Australian Institute of Health and Welfare. Because of the substantial number of subjects lost to follow-up, two methods of analysis were used. Results are presented for the method representing the estimate that is likely to be closest to the true rate. Mortality is expressed as a standardised mortality ratio (SMR), with a confidence interval. The SMR is the ratio of the actual number of deaths in the participants to the number expected if the death rate was the same as in the general Australian population. An SMR greater than 1.0 indicates that the mortality is greater than in the general population, and an SMR less than 1.0 indicates that it is less. However, the SMR calculated using the study data is only an estimate of the true SMR. The confidence interval is a statistical estimate of the likely range within which the true SMR lies. If the lower boundary of the confidence interval exceeds 1.0, we can be reasonably confident that the true SMR exceeds 1.0, in which case the SMR is said to be significantly increased that is, the mortality rate is considered to be higher than in the general population. Conversely, if the upper boundary of the confidence interval is less than 1.0, the SMR is said to be significantly reduced, and the mortality rate is considered to be lower than in the general population. Only statistically significant findings are shown in this summary. A significant increase in SMR does not necessarily mean that it is a large increase. Cancer incidence refers to the rate of occurrence of new cancers, regardless of whether the outcome is fatal. The standardised incidence ratio (SIR) is the ratio of the actual number of cancers in the participants to the number expected if the cancer rate was the same as in the general Australian population. Like the SMR, if the SIR is greater than 1.0, then the test participants have a greater than expected number of cancers. Radiation dosimetry A panel of health physicists (the Dosimetry Panel) was convened to develop estimates of the radiation doses received by participants. These estimates were used to investigate any relationship between radiation and health outcomes. The panel drew on extensive, but not complete, sets of historical and primary documents, kept at organisations such as the Australian Radiation Protection and Nuclear Safety Agency and the National Archives of Australia. Documents relating to the tests held by individuals were also reviewed, and some participants were interviewed to obtain an understanding of the tasks undertaken by work groups at the tests. One of the main sources of information on participants exposure to external radiation is the record of film badges worn during the tests. Although the records are by no means complete, and it is apparent that not all the badges worn were actually processed, there are sufficient numbers to provide a basis for dose estimation. These film badge records have been supplemented by estimates based on measured radiation levels in contaminated areas and the estimated time that participants spent there. Computer calculations have also been used to estimate the dose rates that would arise from ground contamination, and how these would change with time. For internal exposure, such as that resulting from xviii Australian participants in British nuclear tests in Australia Vol 2: Mortality and cancer incidence

19 inhalation of radioactive dusts, virtually no monitoring data were available and only computer modelling could be used. Each participant was assigned an estimated accumulated dose for each test series from the dose rate estimates, the work groups they were in (e.g. military formations, ships companies) and the activities of each work group during that series. On the basis of these estimates, participants were grouped into one of five exposure categories, A to E, which represent effective doses of: A B C D E less than 1 millisievert (msv) 1 to less than 5 msv 5 to less than 20 msv 20 to 50 msv over 50 msv. For some individuals, there is insufficient information on which to base an estimate of the dose; these are assigned to category F: unknown exposure. If an individual attended several test series, the doses were combined. Results Radiation dosimetry The radiological hazards that the participants faced arose mainly from nuclear weapons debris, including fallout, when it was distributed throughout their working environment. Those in areas contaminated by radioactive materials could be exposed to external radiation directly or to internal radiation from inhaled or ingested radioactive material, or to both. The radiation doses received by Australian participants were generally small. Approximately 79% of the participants were assessed as receiving doses less than 1 msv that is, approximately half the annual dose received from natural background radiation. Only 4% received more than 20 msv, the current internationally accepted annual limit for a radiation worker recommended by the International Commission on Radiological Protection. The average accumulated dose to participants was 2.8 msv, approximately equal to the annual dose from natural background radiation. Although many participants have expressed concerns about the radiation dose they may have received from the actual flash of a detonation, exposures from this source were negligible, except in a group of military Indoctrinees who participated in Operation Buffalo at Maralinga in Some groups did receive significant exposures. The main groups who were exposed at the level of category C (5 to less than 20 msv) or higher were: some RAAF aircrew who flew through the contaminated clouds in RAAF or RAF aircraft after nuclear explosions Executive summary xix

20 crew members from HMAS Hawkesbury who assisted in records recovery and participated in Joint Services Training Unit (JSTU) exercises during Operation Hurricane crew and divers from HMAS Koala who recovered a landing craft during Operation Hurricane members of the JSTU who undertook radiation monitoring training during Operation Hurricane members of the Radiation Hazards group at Operation Totem Peace Officers who patrolled contaminated areas Indoctrinee Force members at Operation Buffalo elements of the Maralinga Range Support Unit who provided a range of engineering and support duties in forward areas from Operation Buffalo through to post Operation Antler activities drivers and passengers in contaminated vehicles travelling over contaminated ground members of the Australian Health Physics Group (AHPG) who conducted radiation surveillance members of the AHPG team who collected Cobalt-60 ( 60 Co) pellets after Operation Antler a team that decontaminated and dismantled the DC 12 building in Maralinga Village at the end of the minor trials. This dosimetry study was made independently of a similar UK study that estimated the doses received by British participants in the tests in Australia. The UK dose estimates are broadly similar to those presented here for the Australian participants. Death rates The commonest causes of death in the study group were cancer (1497 deaths) and ischaemic heart disease (coronary artery disease, 1148 deaths). Other leading causes of death were stroke (254); respiratory disease (338); and external causes, including accidents, poisoning and suicide (281). The overall death rate was not significantly different from that in the general Australian male population. There were 4233 deaths observed in participants, compared with 4150 expected from the general population. In RAN personnel, mortality was significantly higher than in the general population. In RAAF personnel, mortality was significantly lower than in the general population. Cancer mortality was 18% higher than in the general male population. Mortality rates for diseases other than cancer were not elevated. Mortality from ischaemic heart disease was significantly lower than in the general population. Mortality from respiratory diseases was close to population rates. The death rate from external causes (suicide, poisonings, injury) was lower than in the general population. The suicide rate was 65% less than the rate in the general population. SMRs by major cause are shown in Table 1. xx Australian participants in British nuclear tests in Australia Vol 2: Mortality and cancer incidence

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